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Gardner, Coffman, Tipton lead call for reforms to Veterans Choice Program

Reforms to the Veterans Choice Program led by U.S. Sen. Cory Gardner (R-CO) and U.S. Reps. Mike Coffman (R-CO) and Scott Tipton (R-CO) would modernize the program’s payment, authorization and referral systems.

In a letter to Department of Veteran Affairs (VA) Secretary Robert McDonald, Gardner, Coffman, and Tipton and other members of Colorado’s delegation wrote that they had received complaints about Health Net, the system used to reimburse non-VA providers, from around the state.

“The effectiveness of the Veterans Choice Program depends on the willingness of non-VA providers to participate in the program, and Health Net’s inability to reimburse these providers in a timely manner — or in some cases, Health Net’s inability to reimburse these providers at all — severely undermines their willingness,” the letter states.

“Some non-VA providers in Colorado have now stopped seeing veterans altogether because of Health Net’s mismanagement. As a result, veterans are not receiving the care they need when they need it.”

The letter called on McDonald to set up a quick response team that would address the backlog of provider reimbursements and to provide an accounting of steps already taken to address lost referrals and authorizations, multiple authorization requirements for procedures and unidentifiable payment denial codes.

“The Choice program was intended to expand and ensure access to care for veterans who are shut out of the system due to its inefficiencies, and allow them to seek care from non-VA providers in the interim,” the letter said. “The idea that any veteran should languish at the bottom of a VA wait list, and be unable to find alternative care due to the VA’s incompetence, is an outrage, and yet these continuous complaints lead us to believe that this is exactly what is happening to our veterans in Colorado who wish to utilize the Veterans Choice Program.”

U.S. Reps. Ken Buck (R-CO) and Doug Lamborn (R-CO) also joined Gardner in sending the letter to McDonald.